Ukukhuluphala kuyinto engozini yokuhluleka kwenhliziyo ngakho ukulahlekelwa isisindo kusenesikhathi kungasiza ekuvimbeleni ukwehluleka kwenhliziyo kamuva. Kodwa kuthiwani ngezinqubo zokuhlinzwa zokulahlekelwa isisindo, njengokuhlinzeka nge-bariatric (ukuhlinzwa kwesisindo) kanye namadivaysi okulahlekelwa kwesisindo esenzelwe ukuhlinzwa? Ingabe labo bangavimbela ukuhluleka kwenhliziyo futhi? Ucwaningo lubonisa ukuthi lokhu kukhanya.
Ukukhuluphala Nezifo Zezinhliziyo
Ukukhuluphala ngokweqile nokukhuluphala ngokweqile yizimo eziyizingozi zokuthuthukiswa kwezinhlobo eziningana zezifo zenhliziyo ezibandakanya ukucindezeleka kwegazi, ukushaya kwenhliziyo, ukufiphaza kwegazi , ukushaya isisu nokuhluleka kwenhliziyo.
Ukwanda ngokweqile kuyimbangela eyaziwa kahle ye-type 2 yesifo sikashukela , esiphezu sayo kanye nesifo esiyinhloko esiphezulu sesifo senhliziyo. Futhi ukukhuluphala kuyimbangela ye-cholesterol ephezulu, eyisizathu esaziwayo sesifo senhliziyo.
Ukwengeza, ukukhuluphala kuyinkinga engozini yomsindo wenhliziyo ongaziwa njenge-fibrification ye-atrial, futhi abantu abane-fibrillation ye-atrial bayengozini yokushaywa yisifo. Ukukhuluphala kungasithinta izici eziningi zesimiso senhliziyo.
Njengoba kuphawuliwe ngenhla, kunezinqubo eziningi ukukhuluphala okubekayo engozini kulezi zimo ezihlukahlukene zezinhliziyo, kodwa kubalulekile ukukhumbula ukuthi ukukhuluphala kunyusela ukuvuvukala emzimbeni wonke, futhi ukuvuvukala kungase kudlale indima ekwenzeni inhliziyo ye-coronary.
Ukwehla komzimba nokuhluleka kwenhliziyo
Okokuqala, yini ukwehluleka kwenhliziyo? Kulula nje, kunezinhlobo ezimbili eziyinhloko zokwehluleka kwenhliziyo : systolic inhliziyo ukwehluleka kanye diastolic inhliziyo ukwehluleka.
In sysilic heart failure, inhliziyo ihluleka ukupompa ngokuvamile; lokhu kuhlotshaniswa nengxenyana encane ye- ejection (isilinganiso somsebenzi wepompo).
In ukwehluleka kwenhliziyo ye-diastolic (kamuva nje eyaziwa ngokuthi ukuhluleka kwenhliziyo nge-fraction ejection egciniwe), ingxenyana ye-ejection iyinto evamile, kodwa inhliziyo isengenawo ngokujwayelekile ngenxa yesisindo senhliziyo esiqinile kakhulu.
Kokubili ukuhluleka kwenhliziyo ye-systolic ne-diastolic kunezimbangela ezihlukahlukene, futhi futhi wabelane ngezimbangela ezithile, ezifana nomfutho wegazi ophezulu, isifo se-coronary disease kanye nokukhuluphala .
Noma yikuphi ukuhluleka kwenhliziyo kungabangela izimpawu zalokho okubizwa ngokuthi ukwehluleka kwenhliziyo, lapho i-fluid iqoqa emaphashini, yenza kube nzima ukuphefumula; uketshezi nakho kungagcina emilenzeni, kubangele ukuvuvukala nokukhululeka.
Ngakho-ke, ngokuhluleka kwenhliziyo, inhliziyo ayikwazi ukupompa ngokujwayelekile noma ngokuphumelelayo ukugcina ukujikeleza okwanele kuwo wonke umzimba.
Ngakho ukukhuluphala kuhlobene kanjani nokuhluleka kwenhliziyo? Esiqondisweni sokuhluleka kwenhliziyo okukhishwe ngo-2013 yi-American College of Cardiology Foundation kanye ne-American Heart Association, ukukhuluphala kubhekwa njengesiqalo sokuhluleka kwenhliziyo.
Lesi siqondiso sichaza ukukhuluphala njengesimo sezokwelapha esingaba, ngokwayo, sibeke umuntu eSiteji A sokuhluleka kwenhliziyo. Isigaba A, njengoba kuchazwe lesi siqondiso sikazwelonke, sihlanganisa bonke "abasengozini enkulu yokuhluleka kwenhliziyo kodwa ngaphandle kwesifo senhliziyo noma izimpawu zokuhluleka kwenhliziyo." Lokhu kusho ukuthi, nakuba umuntu enesisindo angenaso izimpawu noma izimpawu zokuhluleka kwenhliziyo, zisacatshangwa ukuthi zikhona esiteji sokuqala sokuhluleka kwenhliziyo nje ngenxa yokukhuluphala.
Lokhu kwenza isitatimende esinamandla ngokubaluleka kokuphatha ukukhuluphala ukugwema ukuhluleka kwenhliziyo egcwele.
Ukwelashwa kweBariatric Kuthola Ukuvimbela Ukungaphumeleli Kwezinhliziyo
Ngenhlanhla, imizamo yokulahlekelwa isisindo ikhokha, futhi uma unesisindo esingaphezu komzimba ungenza izinyathelo ezinkulu zokuvimbela izifo zenhliziyo, kuhlanganise nokuhluleka kwenhliziyo, ngokulahlekelwa isisindo. Ngisho nokuncane kwesisindo somzimba, ebangeni elingamaphesenti amahlanu kuya kwezingu-10 zesisindo esiningi, kungenza umehluko omkhulu.
Futhi manje ucwaningo luye lwabona ukuthi ukulahlekelwa isisindo ngokuhlinzwa, kuhlanganise nezinqubo ezinjenge- gastric overpass , i-gastrectomy yamaslee, ne- banding banding , futhi ingavimbela isifo senhliziyo njengesifo senhliziyo.
Ku-2016 American Heart Association Scientific Sessions, abacwaningi abaholwa umlobi omkhulu uJohn Sundstrom, MD, PhD, uprofesa we-epidemiology e-Uppsala University eSweden, wanikeza imiphumela yocwaningo olukhulu kakhulu (iziguli ezingaba ngu-40 000 eziphelele) ezathola ukuthi iziguli ngokukhuluphala obekutholwe ukuhlinzeka nge-bariatric kwakungeke kube lula ukuthuthukisa ukwehluleka kwenhliziyo kunabo abangazange bahlinzekwe kodwa esikhundleni salokho bazama izinguquko zendlela yokuphila njengokudla okujulile nokuzivocavoca.
Abacwaningi basho ukuthi imiphumela ephawulekayo yokuhlinzeka nge-bariatric ingase ibe ngenxa yemiphumela yokuhlinzeka nge-bariatric ekunciphiseni izimo ezingozini zokuhluleka kwenhliziyo, njengesifo sikashukela, umfutho wegazi ophakeme, nokufabulisa kwe-atrial.
Ngokwesibonelo, ocwaningweni oluqhutshwa nguJamaly nozakwabo futhi lanyatheliswa kuyi- Journal of the American College of Cardiology ngoDisemba 2016, abalobi bathole ukuthi "uma kuqhathaniswa nokunakekelwa okuvamile, ukulahlekelwa isisindo ngokusebenzisa ukuhlinzwa nge-bariatric kuncishise ingozi ye-fibrillation ye-atrial phakathi kwabantu baphathwe ukukhuluphala ngokweqile. "Okuthakazelisayo ukuthi le ncishiswa yokunciphisa ingozi yayivezwa kakhulu kubantu abasha nakubantu abanezinkinga ezingaphezu kwegazi.
Kumele futhi kuqaphele ukuthi ukuhlinzeka nge-bariatric kungaholela ekulahlekelweni kwesisindo esikhulu esikhathini esifushane, njengoba kuboniswa isifundo sikaDkt. Sundstrom, lapho, ngonyaka owodwa ngemuva kokuhlinzwa, iziguli zazilahlekelwe isilinganiso samapounds angu-41 ngaphezu kwalabo abasebenza Ukushintsha kwendlela yokuphila kuphela (kodwa akukho ukuhlinzwa).
Ezingxenyeni ezinkulu ngenxa yalolu hlobo lokulahlekelwa kwesisindo esisheshayo ngesikhathi esifushane, ukuhlinzwa kwe-bariatric kutholakale ezincwadini eziningi ukuze kubangele ukwehla okuphawulekayo kumazinga wesifo sikashukela nomfutho wegazi ophezulu, okwehlisa ingozi enkulu yesifo senhliziyo ( ngoba kokubili isifo sikashukela kanye nokucindezeleka kwegazi kukhona izifo ezingezinhle zesifo senhliziyo).
Ingabe Ungumuntu Ophethwe Ngama-Bariatric Surgery?
Ngakho-ke, ungase uzibuze ukuthi ungubani ozobhapathizwa nge-bariatric. Khumbula ukuthi kunezinhlobo ezihlukahlukene zokuhlinzekwa kwesisindo sokulahlekelwa, kodwa iningi lalezi zinqubo zinesidingo esifanele sokufaneleka.
Ngokweziqondiso zakamuva zokukhuluphala ngokweqile ezikhishwe yi-American Heart Association (AHA), i-American College of Cardiology (ACC), ne-The Obesity Society (TOS), ukuhlinzeka nge-bariatric kungaba yindlela yokuthola iziguli ezikhulile ezihlangabezana nemigomo ethile.
Lezi zinqubo zifaka inkomba ye-mass mass (BMI) engama-40 noma ngaphezulu, noma i-BMI engama-35 noma ngaphezulu kwesiguli esinezinye izimo zezokwelapha (eyaziwa ngokuthi "izimo ze-comorbid") ezibangelwa ukukhuluphala. Ikomidi lokubhala lokukhuluphala ngokweqile alizange lithole ubufakazi obanele bokuncoma ukuhlinzeka nge-bariatric ngeziguli ezine-BMIs eziwela ngaphansi kwalezi zinsika.
Isiqondiso siqhubeka sinikeza odokotela bokunakekelwa okuyinhloko nabanye abathintekayo iziguli ezinokukhuluphala nge-BMI ephezulu ukuzama "ukwelashwa ngokuziphatha noma ngaphandle kwe-pharmacotherapy" kuqala, bese-ke uma lokhu kungasebenzi kanye nezinye izindlela zokudla nokuphila ukuze kuzuze ukulahlekelwa isisindo esanele, i-bariatric ukuhlinzwa kungacatshangwa.
Ngakho-ke kubalulekile ukuxoxa ngalokhu nodokotela wakho, ngubani ongakusiza ukuthi unqume ukuthi ungumuntu omele ukhetho lokuhlinzeka nge-bariatric futhi uma kunjalo, iyiphi inqubo okufanele uyenze yona.
Ezinye Izindlela Unganciphisa Ingozi Yakho Yezifo Zenhliziyo
Ngaphezu kokulahleka kwesisindo, kunezinye izindlela eziningana ezibalulekile onganciphisa ngazo ingozi yesifo senhliziyo ngokujwayelekile nokuhluleka kwenhliziyo ngokukhethekile.
Okokuqala, yazi izinombolo zakho. Lokhu kusho ukuhlolwa kwe-cholesterol yakho, ukuhlolwa kwengcindezi yakho yegazi, kanye neshukela lakho legazi elihlolwe isandulela ngculazi noma isifo sikashukela. Ukuzikhandla ngempilo yakho kuhlanganisa ukwazi ukuthi uqala kuphi, ukuze ukwazi ukuthi yiziphi izinto ozibekayo engozini futhi ubhekane nayo ngayinye ukuze unciphise ingozi yakho yonke.
Njengoba kuvela, izinguquko eziningi zokuphila ezigcina zonke lezi zinto eziyingozi ekuhloleni zifana, futhi zizokusiza ugcine isisindo esinempilo, futhi. Ukuhola indlela yokuphila enempilo enhle kusho ukuvivinya umzimba nsuku zonke nokulandela imikhuba yokudla enempilo .
Isitayela esisodwa sokudla, ikakhulukazi, siye saboniswa, ngokuphindaphinda, eminyakeni engaphezu kwamashumi eminyaka yocwaningo, ukuvimbela isifo senhliziyo, futhi lokho kungukudla kweMedithera.
Esikhundleni sokudla ukudla okukhethwa yi-fad ukuthi umuntu ukhetha kuphela ngezinhloso zesikhashana zokulahlekelwa isisindo, ukudla okudinga iMedithera kuyindlela yokuphila, indlela yokudla impilo yakho yonke. Lesi yisitayela semvelo sokudla iningi labantu abakhileyo emazweni azungeze uLwandle LwaseMedithera-ngakho igama.
Ukudla kweMedithera kugcizelela ukusetshenziswa kwezithelo nemifino yonke, okusanhlamvu okugcwele, amantongomane emithi, amafutha omnqumo angaphezulu, izinhlanzi nezinkukhu, newayini (ikakhulukazi iwayini elibomvu) ngokulinganisa.
Njengebhonasi eyengeziwe, ukudla kwaseMedithera kuye kwatholakala ukuthi kunomthelela ekunciphiseni isisindo kanye nengozi ephansi yomdlavuza webele .
> Imithombo:
Estruch R, Ros E, Salas-Salvadó J, et al. Ukuvimbela okuyisisekelo isifo senhliziyo nesidlo saseMedithera. N Engl J Med 2013; 368: 1279-1290.
> Jamaly S, uCarlsson L, uPeltonen M, Jacobson P, et al. Ukuhlinzwa kweBariatric kanye nobungozi bokuqala kwe-friday frillation ezifundweni zesiSweden. J Am Coll Cardiol. 2016; 68: 2497-2504.
> Jensen MD, Ryan DH, Apovian CM, et al. Umhlahlandlela we-AHA / ACC / TOS ka-2013 wokuphatha ukwedlula ngokweqile nokukhuluphala kubantu abadala: umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice kanye ne-Obesity Society [eyanyatheliswa ku-intanethi ngoNovemba 27, 2013]. J Am Coll Cardiol.
> Sundstrom J, Bruze G, Ottosson J, uMarcus C, et al. I-American Heart Association Scientific Sessions 2016. Abstract (session post session) yaboniswa bukhoma ngoNovemba 14, 2016.
> Yancy CW, uJessup M. Bozkurt B, Butler J, et al. 2013 ACCF / AHA umhlahlandlela wokuphatha ukuhluleka kwenhliziyo: umbiko we-American College of Cardiology Foundation / American Heart Association Task Force on Guidelines Practice. Ukujikeleza 2013 Jun 5 [Epub ngaphambi kokuphrinta].